Advocacy & Compliance

Healthesystems’ Advocacy & Compliance experts are essential in the management of pharmacy and ancillary benefits for our clients. By tracking and influencing regulatory activity, our team stays ahead of evolving trends and identifies opportunities to advocate on behalf of our clients, their injured workers, and the broader industry.

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The Advocacy &  Compliance Team

Monitors and reports on proposed and pending regulatory changes that impact workers' comp, helping shape effective program strategies

Advocates for fair and balanced public policy through proactive engagement with regulators, customers, and other stakeholders throughout the rulemaking lifecycle

Supports operational compliance by providing guidance to internal stakeholders and external partners during the implementation of new regulatory changes

Regulatory Recap

A weekly e-newsletter informed by the Advocacy & Compliance team to help keep our clients and industry contacts in the know on the latest legislation and policy updates impacting workers’ comp.

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Massachusetts Advisory Council Discusses Medical Fee Schedule

The fee schedule has not been updated since 2009, resulting in low reimbursement rates, which has impacted access to care.

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November 17, 2025

Cost Containment

CMS Finalizes 2026 Medicare Physician Fee Schedule

States that base their workers’ comp fee schedules on the CMS Fee Schedule may adopt these adjustments, which go into effect January 1st.

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November 17, 2025

Access to Care

White House Announces Deal to Expand Access to GLP-1 Medications

Qualifying CMS patients could face a co-pay of $50 a month for these highly popular drugs for obesity and diabetes.

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November 10, 2025

Industry Data

NCCI Reports on Medical Inflation Insights

Headline inflation rose 3% year over year in September, still above the Federal Reserve’s 2% target but well below 2022 levels.

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November 10, 2025

Ancillary Services Claim Costs Claim Data

NCCI Reports on the Latest Trends in Medical Equipment Cost Share

Average medical equipment costs increased 87% from 2012-2024, with medical equipment representing 8.3% of total workers’ comp medical spend.

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November 10, 2025

Claims Procedures

Nevada Publishes FAQ for Upcoming Procedural Reforms

Among many things, the FAQ discusses processes for formulary changes, administrative fines, and provider lists.

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November 10, 2025

Advocacy Opportunity Claims Procedures

California Considers Rule Change for Greater E-Filing in Workers’ Comp

Proposed updates also allow for electronic filing and service of all WCAB case related documents in EAMS rather than requiring service by mail.

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November 10, 2025

Presumptions

Michigan Considers Infectious Disease Presumption for Essential Workers

The bill would apply to those required to work during a state of emergency to protect life or maintain critical operations.

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November 10, 2025

Access to Care Billing & Payments Claims Procedures

Michigan Introduces Bill to Strengthen Injured Worker Protections

The bill impacts required medical services, provider choice, preauthorization requests, and more.

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November 10, 2025

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Further resources you may be interested in

Additional articles and updates from Healthesystems related to policy shaping workers’ comp.

More States Continue with PTSD Legislation

Oklahoma and Rhode Island enact new presumptions, with Georgia adding extra coverage.

Maryland and Arizona Enact New Psychedelic Laws

A Maryland taskforce will plan regulation, while Arizona will tentatively cover MDMA treatment for first responders with PTSD.

Positive Marijuana Screenings Increase – What More to Expect with Rescheduling?

New data from Quest Diagnostics 2024 Drug Testing Index, and industry leaders discuss how rescheduling will impact workers’ comp.

Physician Dispensing Concerns in Workers’ Compensation

Physician dispensing represents an ongoing challenge for today’s workers’ comp payers – not only from a cost perspective, but from clinical and safety perspectives.